Buried sutures vs. full incision—where's the dividing line? Choose by how easily it reverts and scarring

If you choose based on resistance to reversion, incision is the way; if you choose based on minimal scarring and downtime, buried sutures mark the major dividing line. Buried sutures create a fold with thread, so the line can slacken; full incision allows excess skin and fat to be reduced on the spot.[1][2]. Partial incision sits in between, but research comparing long-term outcomes numerically has not yet been found[2].

When does buried suture technique slacken?

What we can say numerically is that susceptibility to re-operation due to slackening varies by condition. A 4.5-year retrospective study reported that the group undergoing buried sutures simultaneously with upper-eyelid fat removal had a lower re-operation rate and longer-lasting Double eyelids shape[1].[1]Another study from the same group showed that the risk of thread slackening and re-operation with 2-point buried sutures differs depending on age group[3]. In other words, durability changes with eyelid thickness and age.

Which eyelids are suited for full incision?

Those with excess skin or fat where you want to stabilize the line. Double eyelid surgery has three pathways—buried sutures, less-invasive partial incision, and full incision—and among them, full incision is reported to be most widely used[2]. The reasons are: excess skin and fat can be cut away on the spot, tissue structure can be confirmed visually as the procedure progresses, and issues with eyelid-lifting force can be addressed at the same time[2].

Can we say that incision never reverts?

We cannot say that definitively. Even with full incision, durability and recurrence patterns can shift depending on how fixation is done, and fixation techniques themselves continue to be refined[4]. Randomized controlled trials directly comparing re-operation rates between buried sutures and full incision are not available, and we are not yet at a stage where we can show numerically which reverts less and by how much. Rather than thinking "incision means it never goes back," it is more accurate to understand it as "it is unlikely to slacken, but change can occur."

How should partial incision be positioned?

It is an option between buried sutures and full incision, but currently the evidence is limited. While organized as one of three major methods,[2], comparative trials isolating partial incision alone and quantitatively verifying durability and complications are not available. Even when there is a wish to minimize scarring, how long it lasts is explained individually based on eyelid condition rather than numerically.

Does thread type change the outcome?

Recent comparisons agree that major outcomes show no difference. A systematic review comparing absorbable and non-absorbable threads in upper-eyelid surgery concluded that clinical results are equivalent[5]. Another comparative study reported no significant differences in scar quality or complication frequency[6]. However, the former acknowledges its own limitation of being based on limited, heterogeneous data, and comparison including the burden of follow-up visits and suture removal remains a future task[5].

Which will you choose?

The order to consider is: eyelid thickness and skin excess, then the number of years you want it to last, and finally ease of scarring and downtime. If skin is excess and the line gets hidden, incision becomes an option; if skin is thin and a fold forms easily, buried sutures may suffice[2]. Since reports show that how slackening appears varies by age,[3], even the same desire can have different answers for different people. Ultimately, have a doctor evaluate your eyelid condition on examination and decide with your doctor including what to do if reversion occurs—this is the most practical approach.